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Background The Coronavirus disease (COVID) pandemic had a devastating effect on physician practices across the globe resulting in lost revenue. In this study, we aimed to determine the impact of the pandemic on cardiologists across the United States. Cardiologists account for 5.8% of physicians in the US but are estimated to be the 2nd most revenue generating specialty ($3.5 million/year). Methods The subjects for the study were Cardiologists with membership to either medical societies American College of Cardiology, Society of Cardiovascular Angiography and Interventions, Heart Rhythm Society, or American Society of Echocardiography. The participants were emailed a survey link with information regarding the study objective, potential risks, and benefits of participation. (Proportional Reporting Ratio) PRR was calculated to compare various characteristics of the responders, exposures, disease impact on self and practice. Results 91%(448) of the cardiologists who responded(n=493) reported some disruption in practice and 46%(226) reported delay in planned elective procedures. Nearly all (92%, 453) reported incorporating telemedicine into their practice. Cardiologists working?>55 hours/week (PRR=1.296, 95% CI =1.023-1.643), urban and semi-urban areas (PRR=1.802, 95% CI=1.468-2.211) and in academic settings (PRR=1.345, 95% CI=1.096-1.652) were at increased risk of developing COVID infection compared to others. Cardiologists performing transesophageal echo had reduced risk of contracting COVID (PRR=0.721,95% CI=0.604-0.861) compared to those performing catheter ablation (PRR=1.382, 95% CI=1.150-1.661) and device placement (PRR=1.208, 95 %CI=1.012-1.442). Conclusion Cardiologists who worked longer hours, practiced in urban/academic settings, worked in centers not requiring preoperative COVID testing and were exposed to COVID positive patients without a Personal Protective Equipment(PPE) were at higher risk of getting infected. Albeit derived from a self-reported physician survey of a small cohort of cardiologists, the patterns of exposure and infection offer insight into practice changes and precautions that might protect physicians in future pandemics.Copyright © 2023 American College of Cardiology Foundation
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PURPOSE/HYPOTHESIS: Individuals with Long COVID experience a variety of symptoms (cardiopulmonary, neurological, musculoskeletal, and psychological) for 12 weeks or more after being infected with COVID-19. Preliminary evidence suggests exercise to be beneficial in alleviating short-term COVID-19 symptoms. The purpose of this investigation is to assess the impact of a progressive therapeutic exercise program on individuals with Long COVID. NUMBER OF SUBJECTS: Ten participants (8 females, 2 males) with Long COVID (age=49 +/- 5 yrs, mass = 89 +/- 6 kg, BMI = 30.2 +/- 1.9 kg/m2) were enrolled in the study. MATERIALS AND METHODS: Before and after the intervention participants were assessed for 6-minute walk distance (6MWD), 5-times sit to stand (5XSTS), gait speed, grip strength, perceived quality of life (SF-12), and general fatigue (visual analog fatigue scale, VAFS). Participants then completed a progressive, individualized exercise program (;8 weeks) designed to improve cardiovascular fitness, muscle strength, and endurance. Modes of exercise used to facilitate improvement in cardiorespiratory fitness included the treadmill, NuStep, semirecumbent bike, semi-recumbent elliptical, and standup elliptical. Heart rate (HR), blood pressure (BP), O2saturation, and rating of perceived exertion (RPE) were regularly monitored during aerobic exercise. Dumbbell exercises targeted at large muscle groups were used to challenge muscular strength and endurance. Progression of exercise intensity and duration was based on symptom response to exercise. Paired t-tests were used to evaluate changes in outcome measures following the intervention. RESULT(S): 6MWD (pre = 469 +/- 19 m, post=529 +/- 18 m, P = .001), 5XSTS (pre=11.4 +/- 1.1 s, post=9.4 +/- 0.9 s, P = .012), gait speed (pre=1.24 +/- 0.05m/s, post=1.35 +/- 0.07m/s, P = .029), and right (pre=69.8 +/- 4.2lbs, post=73.6 +/- 4.4lbs;P = .041) and left (pre=64.7 +/- 3.5lbs, post=68.8 +/- 3.1lbs;P = .041) grip strength improved following the intervention. Similarly, both the physical component (pre=44.4 +/- 3.1, post=50.76 2.4, P = .006) and mental component (pre=43.9 +/- 2.9, post=51.4 +/- 2.0, P = .007) of SF-12 improved, while VAFS (pre54.86 0.5, post52.86 0.6, P5.005) was reduced following the intervention. CONCLUSION(S): A progressive individualized exercise program can be effective at improving physical function and perceived quality of life in Long COVID patients. CLINICAL RELEVANCE: Many physicians are referring patients out to be treated for Physical Therapy, but there is currently limited reference of evidence-based practice to treat these individuals and some concern that exercise may exacerbate symptoms. The majority of APTA clinical guidelines for COVID-19 focus on short-term COVID-19 symptoms and do not address treatment methods for Long COVID symptoms. While functional status has been demonstrated to be negatively impacted in Long COVID patients, little guidance is available for treatment strategies in this population. This investigation provides physical therapists with a generalized strategy to improve physical function and quality of life in Long COVID patients.
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PURPOSE/HYPOTHESIS: Individuals with Long COVID experience a variety of symptoms (cardiopulmonary, neurological, musculoskeletal, and psychological) for 12 weeks or more after being infected with COVID-19. Preliminary evidence suggests exercise to be beneficial in alleviating short-term COVID-19 symptoms. The purpose of this investigation is to assess the impact of a progressive therapeutic exercise program on individuals with Long COVID. NUMBER OF SUBJECTS: Ten participants (8 females, 2 males) with Long COVID (age=49 +/- 5 yrs, mass = 89 +/- 6 kg, BMI = 30.2 +/- 1.9 kg/m2) were enrolled in the study. MATERIALS AND METHODS: Before and after the intervention participants were assessed for 6-minute walk distance (6MWD), 5-times sit to stand (5XSTS), gait speed, grip strength, perceived quality of life (SF-12), and general fatigue (visual analog fatigue scale, VAFS). Participants then completed a progressive, individualized exercise program (;8 weeks) designed to improve cardiovascular fitness, muscle strength, and endurance. Modes of exercise used to facilitate improvement in cardiorespiratory fitness included the treadmill, NuStep, semirecumbent bike, semi-recumbent elliptical, and standup elliptical. Heart rate (HR), blood pressure (BP), O2saturation, and rating of perceived exertion (RPE) were regularly monitored during aerobic exercise. Dumbbell exercises targeted at large muscle groups were used to challenge muscular strength and endurance. Progression of exercise intensity and duration was based on symptom response to exercise. Paired t-tests were used to evaluate changes in outcome measures following the intervention. RESULT(S): 6MWD (pre = 469 +/- 19 m, post=529 +/- 18 m, P = .001), 5XSTS (pre=11.4 +/- 1.1 s, post=9.4 +/- 0.9 s, P = .012), gait speed (pre=1.24 +/- 0.05m/s, post=1.35 +/- 0.07m/s, P = .029), and right (pre=69.8 +/- 4.2lbs, post=73.6 +/- 4.4lbs;P = .041) and left (pre=64.7 +/- 3.5lbs, post=68.8 +/- 3.1lbs;P = .041) grip strength improved following the intervention. Similarly, both the physical component (pre=44.4 +/- 3.1, post=50.76 2.4, P = .006) and mental component (pre=43.9 +/- 2.9, post=51.4 +/- 2.0, P = .007) of SF-12 improved, while VAFS (pre54.86 0.5, post52.86 0.6, P5.005) was reduced following the intervention. CONCLUSION(S): A progressive individualized exercise program can be effective at improving physical function and perceived quality of life in Long COVID patients. CLINICAL RELEVANCE: Many physicians are referring patients out to be treated for Physical Therapy, but there is currently limited reference of evidence-based practice to treat these individuals and some concern that exercise may exacerbate symptoms. The majority of APTA clinical guidelines for COVID-19 focus on short-term COVID-19 symptoms and do not address treatment methods for Long COVID symptoms. While functional status has been demonstrated to be negatively impacted in Long COVID patients, little guidance is available for treatment strategies in this population. This investigation provides physical therapists with a generalized strategy to improve physical function and quality of life in Long COVID patients.
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The COVID-19 pandemic has had disproportionate effects on communities of color, with higher death rates among African Americans (AA). The purpose of this study was to assess associations in African Americans' mental and physical health with the COVID-19 pandemic. Data for this study came from a larger nutrition intervention of AAs in the Southeastern United States, the Nutritious Eating with Soul study. Data collected before and after March 15, 2020 (the day when local South Carolina schools and businesses closed), were analyzed to assess the association of the pandemic on participants' stress, control of healthy eating, physical activity, and body mass index. Repeated measures analysis of covariance using full maximum likelihood estimation to handle missing data was used. At the onset of the COVID-19 pandemic, 150 participants were enrolled in the study (48.2 ± 10.6 years old, 79% female, 75% with college degree or higher). Participants' reporting of stress did not show statistically significant change over time. Cognitive control increased 1.43 points (F = 20.60, p < 0.0001) and body mass index increased 0.72 kg/m2 (F = 10.68, p = 0.001). Future longitudinal studies should investigate how the COVID-19 pandemic continues to present challenges to understanding and improving health among African Americans. The study is registered at www.clinicaltrials.gov NCT03354377.
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BACKGROUND: The U.S. public health response to COVID-19 has been widely criticized as having downplayed the potential implications COVID-19 could have on one's personal health. Despite the unprecedented threat of COVID-19, many individuals still believed that it was not at all likely that they would become infected. We examined: (1) the yearlong trend of adults' perceived susceptibility to COVID-19, (2) whether distinct trajectories emerged, and (3) whether the trajectories differed by participant sociodemographic characteristics. METHODS: Participants from Chicago were recruited from one of five ongoing NIH-funded studies managed by our research team. Data was collected at five timepoints, where participants were asked about their susceptibility to COVID-19, in addition to their socio-demographic and health-related data. We identified groups of individuals following similar progressions of perceived susceptibility to COVID-19 and classified them into trajectory groups using the traj command in Stata. Associations between participant characteristics and their trajectory group were examined in bivariate analyses. Additionally, a multivariable Poisson model was used to estimate relative risks of following a certain trajectory. RESULTS: Nearly two-thirds (62.2%) of participants perceived themselves to be highly susceptible to COVID-19 from the onset of the pandemic ('early responders') and sustained this over a year, 29.0% eventually perceived themselves to be highly susceptible ('late responders'), and 8.8% maintained a low likelihood of susceptibility throughout the pandemic ('non-responders'). In multivariate analyses, compared to White participants, Latinx participants were significantly more likely to be non-responders and report low likelihood of perceived susceptibility (RR: 3.46;95% CI: 1.19, 10.1), as were Black participants (RR: 5.49;95% CI: 2.19, 13.8). CONCLUSIONS: A year into the COVID-19 pandemic, 1 out of 11 participants persistently did not think they might be susceptible and potentially infected. Future studies are needed to understand reasons why certain individuals, particularly those of racial/ethnic minorities, did not perceive themselves at risk for infection.
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BACKGROUND: In the face of the COVID-19 pandemic, the Defence Science and Technology Laboratory (Dstl) and Defence Pathology combined to form the Defence Clinical Lab (DCL), an accredited (ISO/IEC 17025:2017) high-throughput SARS-CoV-2 PCR screening capability for military personnel. LABORATORY STRUCTURE AND RESOURCE: The DCL was modular in organisation, with laboratory modules and supporting functions combining to provide the accredited SARS-CoV-2 (envelope (E)-gene) PCR assay. The DCL was resourced by Dstl scientists and military clinicians and biomedical scientists. LABORATORY RESULTS: Over 12 months of operation, the DCL was open on 289 days and tested over 72 000 samples. Six hundred military SARS-CoV-2-positive results were reported with a median E-gene quantitation cycle (Cq) value of 30.44. The lowest Cq value for a positive result observed was 11.20. Only 64 samples (0.09%) were voided due to assay inhibition after processing started. CONCLUSIONS: Through a sustained effort and despite various operational issues, the collaboration between Dstl scientific expertise and Defence Pathology clinical expertise provided the UK military with an accredited high-throughput SARS-CoV-2 PCR test capability at the height of the COVID-19 pandemic. The DCL helped facilitate military training and operational deployments contributing to the maintenance of UK military capability. In offering a bespoke capability, including features such as testing samples in unit batches and oversight by military consultant microbiologists, the DCL provided additional benefits to the UK Ministry of Defence that were potentially not available from other SARS-CoV-2 PCR laboratories. The links between Dstl and Defence Pathology have also been strengthened, benefitting future research activities and operational responses.
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Children with a Central Nervous System (CNS) tumour have frequent magnetic resonance imaging (MRI) scans during their disease trajectory. Younger children routinely have these performed under general anaesthetic (GA) with an associated risk and inconvenience. Our project over a two-year period was to introduce a structured programme to any child over the age of five years old to achieve an MRI scan without the need for a GA. Thirtysix patients took part. The motivation behind this project was to enhance the hospital experience for patients and their families, lessen time spent in hospital and minimise risk. In addition, there was an added incentive of cost saving and increased availability of GA scans for other specialities within the hospital setting. During the COVID pandemic, it has also resulted in a reduction of our patients requiring COVID swabs, and isolation and in turn a reduction in aerosol generating procedures. As part of the structured programme, each child had an initial assessment with the nurse specialist followed by a minimum of one play preparation session with the play specialist. Children were required to demonstrate they could follow simple instructions, engage in social stories and role-play with hospital equipment and specialised resources. During these sessions, the children visited the MRI department where they practiced lying flat on the MRI bed as it moved into the scanner. Over the two-year period, of the total number of MRI scans performed, the amount of MRI scans requiring a GA reduced from 41% to 31%. The quality of the MRI scans was scrutinised and shown not to be significantly affected. In summary, by introducing a structured programme, it is possible to significantly reduce the need for GA in children requiring CNS imaging as part of their tumour journey.
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RATIONALE: There has been a sustained interest in chronic cough, defined as 8 to 12 weeks of daily coughing (adults) or 4 weeks (children). The interest was initially driven by discrimination of cough based on etiology and response to therapy, and the proposed diagnosis of refractory chronic cough when other major etiologies have been excluded. Perhaps not coincidentally, the convergence of cough counting as a valid method of assessing response to therapy (necessary and sufficient) with the clinical development of first generation P2X3 inhibitors has led to the emergence of a number of patient-oriented devices that claim to count coughs. The emergence of “COVID cough” and “post COVID cough” have heightened the interest in cough. METHODS: The Strados Labs RESPTM has been validated to count coughs. Presented are three methods to count coughs in a continuous recording, in order of increased automation. Each validated method has been confirmed to be within +/- 10% of the true cough count for the gold standard recordings. Each method is validated using >6 patients (>48 hours) of continuous recordings. Number of coughs are annotated by trained professionals and are then reviewed by clinical professionals. This is the gold standard cough count. Cough Counting Methods:1.Multiple trained labelers listen to the recordings and agree on if a sound is a cough or not. The number of agreed upon coughs are added together to determine a total cough count. 2.A highly sensitive machine learning algorithm highlights samples that have a probable likelihood of a cough. Multiple trained labelers listen to recordings and agree if a cough or not. 3.Fully automated machine learning algorithm. RESULTS: In comparison with the gold standard, the highly sensitive method was (>98% sensitivity, and the fully automated machine learning algorithm is >90% specific and >90% accurate and reports the number of coughs. CONCLUSIONS: The process shown here is both necessary and sufficient to validate cough data collection using the RESP. However, unlike other approaches, the RESP provides significant quantitative and qualitative data beyond counting coughs. The RESP provides spectrograms and chest wall motion as well as archival recordings so that parsing coughs into single, multiple and spasms can be reclassified as the data set and science expand. Cough architecture can be evaluated to differentiate intrathoracic from extra-thoracic cough, cough onset in inspiration versus expiration, and response to therapy in real time and with increased anatomic certainty.
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As a career in creative arts therapy grows, new opportunities appear. In this chapter you will meet Tally Tripp, an art therapist who has become an international consultant on using art therapy to deal with trauma;Philip Weglarz, an expressive arts therapist who has moved into the classroom to train graduate students;and Barbara McKechnie, a creative arts therapist who has been a life-long learner, seeking training in additional creative arts therapy fields in order to serve her clients in the most informed and ethical manner. Ruthlee Adler is a music therapist who wrote a book to integrate children with and without disabilities through music;and Paula Patterson discovered she could not limit herself to credentialing in only one creative arts therapy. Finally, Jamie McCoppin discovered many new skills and techniques when she had to transition from face-to-face interactions with clients to online platforms during the COVID-19 pandemic. © 2022 Taylor & Francis.
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The COVID-19 pandemic raised concerns that academic skills would wither away during the lockdown and with it, social-emotional skills. This is assumed to be as true for neurotypical students as for neurodiverse ones. When students return to their schools, how will they function again in their social environment? The key to addressing the transition back to the “new normal” is the arts, which encompass the whole child: cognition, emotions, social, and physical aspects. This article highlights how creating Barrier-Free Theater programs that include drama, music, dance, art, and creative writing could help all students regain the academic progress they have lost, and with the support of creative arts therapists, could lead to the blossoming of a welcoming and inclusive school community in which everyone, regardless of difference, is valued for their innate creativity and human spirit. Barrier-Free Theater can be integrated in classroom curricula, after-school programs, or with community-school partnerships. Creative arts therapists approach students from a strengths-based perspective. We share processes and strategies to incorporate Barrier-Free Theater, where participants are provided the opportunity to make choices, be respected, and learn through solving problems together. This holistic group process allows the arts to heal trauma and disconnection, while enhancing executive functioning and social-emotional connections. © 2022 Taylor & Francis Group, LLC.
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Background: At the outbreak of the pandemic in Chicago, there were disruptions in daily life, communication and delivery of healthcare services. Our objective was to investigate mental well-being, lifestyle behaviors, self-management capacity and healthcare utilization during the early months of the COVID-19 pandemic among older adults with one or multiple chronic conditions. Methods: Telephone interviews were conducted as part of the ongoing COVID-19 & Chronic Conditions (C3) study between March and May 2020. Participants were recruited from local academic and safety net clinics and participated in existing research studies prepandemic. Self-report items assessed perceived stress due to coronavirus, self-management capacity and healthcare utilization. Validated measures assessed well-being, alcohol consumption, physical activity and self-efficacy. Results: The average age of participants (N=565) was 62.4, most were female (61.4%), and over half (n=310) were non-White or Latinx. One in five (20.7%) participants were stressed about the coronavirus most or all the time. Almost a quarter (22.3%) engaged in hazardous drinking and 79.7% reported insufficient physical activity. Nearly one in four participants (23.7%) avoided seeking medical care due to worry about COVID-19. In multivariable analyses, women reported more stress than men. Greater COVID-19 related stress and low health activation were associated with less physical activity, lower self-efficacy, greater difficulty managing health/medications and more avoidance of medical care. Conclusion: Consequences of COVID-19 on the mental wellbeing, lifestyle and ability of adults with chronic conditions to manage health were apparent in the initial months of the pandemic. As the C3 study is ongoing, it will be possible to examine pre- and postpandemic factors over time to understand the influence of the pandemic on the overall health trajectories of older adults.
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The Covid-19 pandemic has put healthcare and care workers in the UK under unprecedented pressure. For nurses, the pandemic has highlighted and exacerbated many of the pre-pandemic problems, including inequality, inadequate working conditions and chronically overburdened workloads. King's Fund's recent report, The Courage of Compassion: Helping nurses and midwives deliver high-quality care, investigated important changes to the nurse's work environment. nurses and midwives needed to help them thrive and thrive at work. This paper presents some of the key research findings and questions what needs to be done to better support nurses working in the community, now and in the future.
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INTRODUCTION/HYPOTHESES: Airway intubation is essential for critical care. Prompted by COVID restrictions on in-person instruction, we evaluated a novel method of remotely training airway intubation: livestreaming in immersive virtual reality (VR). We hypothesized that performance on the procedure, confidence, and subjective experience ratings would be higher for training with VR than a 2D display control. METHOD: 26 preclinical medical students participated (Mage=24 years, SD=2.2 years;50% were female). After IRB approval, 13 participants were assigned randomly to each condition: VR or 2D display (control). Participants used either VR or 2D display to receive instruction on airway intubation. Participants reported their confidence pre/posttraining and rated their experience with the technology on Likert items. Participants then attempted the procedure on a manikin using a video assisted laryngoscope. RESULTS: The average percent correct on the airway intubation procedure was 68% in the VR group (SD=19%) and 60% in the 2D group (SD=22%), but performance did not differ significantly by group (t[24]=0.996, p=.17, d=0.39, all reported p values are 1-tailed). Both groups reported more confidence following training (F[1,24]=72.89, p< .001, ηp 2=0.75), but confidence did not differ by group (F[1,24]=0.797, p=0.38, ηp 2=0.03). On the Likert items, participants rated VR as a more acceptable format than 2D display for airway intubation training (t[24]=1.691, p=.05, d=0.66), and rated the sound quality higher for VR (t[24]=1.712, p=.05, d=0.68). The other Likert items were rated in the predicted direction but did not reach significance: Enjoyment (t[19.81]=1.157, p=.13, d=0.45), Satisfaction (t[24]=1.254, p=.11, d=0.49), and Acceptability of Camera Placement (t[24] = 0.494, p=.31, d=0.19). Usability scores also did not differ by group (t[23]=-.200, p=.42, d=-0.08). CONCLUSIONS: Medical students rated VR as more acceptable for training airway intubation than a 2D display, but VR did not significantly affect performance or confidence when compared to an instructionally-equivalent 2D display condition. Most results were in the predicted direction with medium effect sizes, but statistical power was only sufficient for large effect sizes. Thus, further research is warranted on the degree to which VR adds value to remote training. .
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Introduction: The COVID pandemic has significantly impacted educational development and delivery, yet there is little quantitative research on this topic. The primary objective of this study was to compare the total number of Emergency Medical Service (EMS) Refresher (ER) course completions during 2020 versus prior years. Secondary outcomes examined in person versus on-line/distributive learning during the study period. Methods: The Commission on Accreditation for Prehospital Continuing Education (CAPCE) is the only national organization that accredits continuing education (CE) for paramedics and EMTs and currently has a database with over 14 million CE records. The total number of ER course completions each month in 2020 were compared to 2019 and 2018. We also compared the different educational format types: live in-person (LIP), asynchronous on-line distributive learning (DL), and virtual instructor lead training (VILT) synchronous DL courses. Data was analyzed using descriptive and two-way ANOVA statistics. Results: There were 1,922,783 ER course completions in 2020 versus 1,166,335 in 2019 and 1,074,636 in 2018, representing a 179% increase during the study period. Asynchronous DL course completions in 2020 were 1,830,513 EMS versus 1,078,580 in 2019 and 987,749 in 2018 a 185% increase over the three-year study period. Asynchronous DL monthly means by year was statistically significant, F(2, 99) = 95.632, p < .001. Mean monthly LIP and VLIT educational deliveries by year were not significantly different, p = .802, p = .754, respectively. Total LIP course completions in 2020 were 20,045 versus 51,552 in 2019 and 63,058 in 2018. In 2020 LIP courses made up only 1.0% (20,045/1,922,783) of all ER completions. This study was limited to only EMS professionals taking ER course completions in the CAPCE database. However EMS is not unique, since previous research has suggested that DL has flourished in other health care disciplines while LIP courses have continued to decrease. Conclusion: This large nationwide study of EMS profession has shown the trend toward DL education and a trend away from LIP courses. Future studies should examine the advantages and disadvantages of DL education.
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COVID-19 , Emergency Medical Services , Emergency Medical Technicians , Allied Health Personnel , COVID-19/epidemiology , Humans , LearningABSTRACT
Purpose: In 2008, the author wrote on the Concept of “Money Laundering Control: The Missing Link in Trinidad and Tobago. Now, approximately two years after that seminal assessment, the author has re-assessed the domestic anti-money laundering (AML) framework, with particular reference to the controls in place to address money laundering (ML) and the confiscation of the proceeds of crime. This paper aims to assess the efficiency and effectiveness of the newly implemented regime and considers whether it meets international standards. Design/methodology/approach: This analysis embraces a pluralist approach. Within this assessment, a case study method is used with contextual qualitative analysis. Empirical data is analyzed and causal connections are linked to the analysis. Findings: This research highlights catalytic change and creativity in addressing deficiencies within the AML architecture in Trinidad and Tobago. Upon analysis, it is pellucid that a radically altered criminal justice landscape has emerged and a more aggressive and targeted approach to address ML and the confiscation of the proceeds of crime is apparent. The result is a shift in paradigm with tangible outcomes to suggest that the strategies have borne fruit and that the twin island Republic is indeed committed to strengthening the link. Research limitations/implications: Findings are limited to Trinidad and Tobago and to the period ended April 2020. Originality/value: As a country with a medium to high ML risk, the possible negative socio-economic effects of ML cannot be underscored. Disruption of ML and the confiscation of the proceeds of crime are, therefore, imperative. This paper considers the progress made in addressing these pertinent issues and assists in assessing the effects of the reformation efforts undertaken by Trinidad and Tobago. © 2021, Emerald Publishing Limited.
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Objective: To describe a case of a critically ill patient with acute refractory respiratory failure and ARDS managed via a commonly used social media site (WhatsApp) between an International center with ECLS capability and a well-experienced ECLS center-based thousands of miles away in the United States. Methods: A case report. Covid19, a pandemic declared by WHO, ushered in innovation and new technologies, such as video patient conference calls, telemedicine appointments. The impact of social media has also played a considerable role in linking clinicians globally with using platforms such as Zoom or Microsoft Teams to enhance patient care and management. Results: A 41 yr male was admitted to a tertiary hospital in Hyderabad, India, with worsening acute hypoxic respiratory failure, ARDS secondary to influenza pneumonia amidst a devastating pandemic(tested negative for SARS-CoV-2 infection). Tertiary hospital in Hyderabad, being an ECLS capable center but limited by experience in long-term venovenous ECMO management, sought assistance from Allegheny General Hospital, Pittsburgh PA, via a professional media platform LinkedIn. A WhatsApp group was created. The two centers dynamically exchanged 24/7 basis protocols on analgo-sedation, anticoagulation, and veno-venous ECMO weaning, including the critically ill patient's daily care goals. The fruits of 21 days of aggressive VV ECMO support, consideration for an early tracheostomy resulted in a successful trial off ECLS and active pulmonary -physical rehabilitation care placement. The patient returned to the community with an improved physical and mental condition. Conclusions: We describe a unique International collaboration between an ECMO capable center with less experience in managing ECMO and a large ELSO certified center of excellence via a social media platform in the successful outcomes of a critically ill patient ARDS supported by veno venous ECMO. Issues of patient confidentiality and liability, linking of resources are areas of ongoing needed conversation.